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Kurishima H, Yamada N, Noro A, Tanaka H, Takahashi S, Tsuchida K, Mori Y, Aizawa T. Preserving medial iliofemoral ligament avoids excessive leg lengthening in total hip arthroplasty using anterolateral-supine approach. J Orthop 2025; 60:29-34. [PMID: 39345678 PMCID: PMC11437599 DOI: 10.1016/j.jor.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 09/05/2024] [Indexed: 10/01/2024] Open
Abstract
Background In this study, we compared postoperative leg length discrepancy (LLD) after total hip arthroplasty using the anterolateral-supine approach (ALSA THA) with or without medial iliofemoral ligament (mILFL) preservation and examined the effect of the remaining mILFL on postoperative LLD. Methods This was a single-center, retrospective case control study. Unilateral primary THA with a preoperative LLD <15 mm, in which the contralateral side was intact, was included. After ALSA THA, we compared the absolute values of postoperative LLDs and examined the ratio of postoperative LLD >5 mm with and without mILFL preservation. Demographic data, clinical scores, and operative data were collected. Statistical significance was set at p < 0.05. Results We included 341 hips (preservation group: 283 hips; resection group: 58 hips). The mean (range) absolute values of the postoperative LLDs were 2.3 (0-15.9) mm and 3.4 (0-14.8) mm, respectively. There was no significant difference between the two groups (p = 0.36). The proportion of postoperative LLD >5 mm differed significantly between the groups (4.4 % and 20.0 %, respectively; p < 0.01). Multiple logistic regression analysis showed that resection of the mILFL was the only significant factor that caused excessive leg lengthening (odds ratio, 5.28; 95 % confidence interval, 2.12-13.10, p < 0.01). Significant differences were reported in surgical time (81 (38-132) and 96 (54-157), respectively; p < 0.01) and intraoperative blood loss (297 (50-1170) and 388 (100-1150), respectively; p < 0.01). However, no significant differences in clinical scores, dislocation (including instability), or reoperation rates were observed between the two groups. Conclusion In patients with a preoperative LLD <15 mm, preserving the mILFL in ALSA THA avoids excessive leg lengthening and may lead to shorter LLD without any difficulties.
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Affiliation(s)
- Hiroaki Kurishima
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Norikazu Yamada
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Atsushi Noro
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Hidetatsu Tanaka
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Shusuke Takahashi
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Kyota Tsuchida
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
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Uchida T, Soma T, Kanda M, Kawakami F, Kawahara S, Ikeda N, Matsushita I. Changes in rotator movement during early gait acquisition in after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2024; 119:106333. [PMID: 39191044 DOI: 10.1016/j.clinbiomech.2024.106333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 08/16/2024] [Accepted: 08/21/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND In walking in healthy adults, rotation of the hip joint affects stride length and shifts the center of gravity, but these are not seen in hip osteoarthritis which affects gait. In gait of total hip arthroplasty, there are few reports on changes in the horizontal plane. This study clarified the preoperative and early postoperative gait characteristics of patients undergoing total hip arthroplasty. METHODS The analysis included 12 females who underwent initial total hip arthroplasty using a posterolateral approach. Gait was measured pre and postoperatively using a three-dimensional motion analysis device. Statistics were compared pre and postoperative range of motion, muscle strength, walking speed, stride length, gravity movement distance, trunk angle, hip joint angle, and joint moment. FINDINGS The maximum hip abduction moment and trunk flexion angle to the surgical side were lower than in healthy subjects. The angle of internal rotation during the stance phase was significantly higher in the postoperative period. The distance of the center of gravity shift in the left and right directions was significantly decreased postoperatively. INTERPRETATION Gait disturbance was seen preoperatively and remained after surgery. Walking after total hip arthroplasty provides the hip joint rotates inward which is closer to normal walking. However, no change was observed in the external rotation moment of the hip joint during walking. We suspect that the invasiveness of the posterolateral approach of total hip arthroplasty affects the muscles for external rotation of the hip joint. This can also cause in gait disturbances.
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Affiliation(s)
- Takahiro Uchida
- Department of Rehabilitation Center, Kanazawa Medical University Hospital: 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan.
| | - Toshio Soma
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Motoki Kanda
- Department of Rehabilitation Center, Kanazawa Medical University Hospital: 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan
| | - Fumitsugu Kawakami
- Department of Rehabilitation Center, Kanazawa Medical University Hospital: 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan
| | - Seiko Kawahara
- Department of Rehabilitation Center, Kanazawa Medical University Hospital: 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan
| | - Noriko Ikeda
- Department of Rehabilitation Center, Kanazawa Medical University Hospital: 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan
| | - Isao Matsushita
- Department of Rehabilitation, Kanazawa Medical University, Japan
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Ogura K, Takegami Y, Kuwahara Y, Tokutake K, Nakashima R, Yamamoto S, Naito K, Kasai T, Makida K, Imagama S. Comparison of conjoined tendon-preserving posterior approach and conventional posterolateral approach in hemiarthroplasty for femoral neck fracture in the elderly: A multicenter (TRON group) retrospective study. J Orthop Sci 2024:S0949-2658(24)00097-6. [PMID: 38811337 DOI: 10.1016/j.jos.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Femoral neck fractures (FNF) are one of the most common traumatic injuries in the elderly. The conjoined tendon-preserving posterior (CPP) approach was developed as a modification of the conventional posterolateral (PL) approach in hemiarthroplasty (HA) for displaced femoral neck fractures (FNF) to reduce postoperative dislocation. We hypothesized that the CPP approach would result in fewer dislocations and similar functional and radiographic outcomes compared to the PL approach. PATIENTS AND METHODS This was a retrospective multicenter (TRON group) study. We evaluated the rate of complications, and functional and radiographic outcomes for patients aged >65 years who underwent HA via the PL approach or the CPP approach from 2017 to 2019 and followed up for at least 24 months. To adjust for baseline differences between the groups, a propensity score-matching algorithm was used in a 1:1 ratio. RESULTS We identified 135 patients who underwent HA via the PL approach and 135 patients via the CPP approach. The mean follow-up period was 32.4 ± 14.0 months. The incidence of dislocation was 6 in 135 patients (4.4%) in the PL group and 0 in 135 patients (0%) in the CPP group, and there was significant difference (p = 0.04). Operation time was equivalent between the two groups (73.1 ± 30.4 vs. 71.8 ± 30.0 min; p = 0.72). The rate of varus insertion of stems in the PL group lower than that in the CPP group (19.3% vs. 33.3%; p = 0.01). Postoperative Parker's mobility score was similar between the two groups at 12 months follow-up (6.17 vs. 6.27; p = 0.81). CONCLUSION The CPP approach showed a significantly lower dislocation rate, similar functional outcome and more varus stem insertions compared with the PL approach in this retrospective study.
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Affiliation(s)
- Keisuke Ogura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yutaro Kuwahara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeto Yamamoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Naito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takehiro Kasai
- Department of Orhopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Kazuya Makida
- Department of Orhopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Zhou X, Chen T, Jiang YL, Chen DB, Tian ZY. Comparison of the clinical outcomes between proximal femoral nail anti-rotation with cement enhancement and hemiarthroplasty among elderly osteoporotic patients with intertrochanteric fracture. BMC Musculoskelet Disord 2024; 25:290. [PMID: 38622692 PMCID: PMC11017484 DOI: 10.1186/s12891-024-07414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The proximal femoral nail anti-rotation (PFNA) with cement enhancement enhances the anchorage ability of internal fixation in elderly with osteoporotic intertrochanteric fracture. However, whether it is superior to hemiarthroplasty is still controversial. The present study aimed to determine which treatment has better clinical outcomes among older patients. METHODS We retrospectively analyzed 102 elderly patients with osteoporosis who developed intertrochanteric fractures and underwent PFNA combined with cement-enhanced internal fixation (n = 52, CE group), and hemiarthroplasty (n = 50, HA group) from September 2012 to October 2018. All the intertrochanteric fractures were classified according to the AO/OTA classification. Additionally, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion rates, postoperative weight-bearing time, hospitalization time, Barthel Index of Activities Daily Living, Harris score of hip function, visual analog (VAS) pain score, and postoperative complications were compared between the two groups. RESULTS The CE group had significantly shorter operative time, lesser intraoperative blood loss, lower blood transfusion rate, and longer postoperative weight-bearing time than the HA group. The CE group had lower Barthel's Index of Activities of Daily Living, lower Harris' score, and higher VAS scores in the first and third months after surgery than the HA group, but no difference was observed between the two groups from 6 months to 12 months. There was no significant difference in the total post-operative complications between the two groups. CONCLUSION The use of PFNA combined with a cement-enhanced internal fixation technique led to shorter operative time and lesser intraoperative blood loss and trauma in elderly patients as compared to HA.
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Affiliation(s)
- Xiang Zhou
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - Tao Chen
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - Yu-Lin Jiang
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - De-Bin Chen
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - Zhi-Yong Tian
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China.
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Xin P, Ni M, Ji Q, Yang X, Geng L, Wang Y, Zhang G. Using mesh in capsule anatomical reconstruction to enhance the stability of high-dislocation-risk hip arthroplasty: a randomized controlled trial. J Orthop Surg Res 2023; 18:102. [PMID: 36788575 PMCID: PMC9926545 DOI: 10.1186/s13018-023-03575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Dislocation is a common complication after total hip arthroplasty (THA). This study aimed to compare the outcomes of mesh reconstruction versus conventional capsular repair in maintaining capsular integrity and preventing dislocation after THA. METHODS This was a prospective, randomized controlled study of consecutive patients. A total of 124 high-dislocation-risk THAs were identified and randomized into two groups, one using mesh reconstruction and the other using the conventional capsular repair method. Perioperative data and radiological data were collected. Patients were followed up regularly. The main indices were the capsular integrity assessed by magnetic resonance imaging (MRI) and hip dislocation rate. The secondary indices included the Harris hip score (HHS), complications, and satisfaction. RESULTS A total of 106 patients completed the follow-up and the average follow-up times were 19 ± 3.1 and 18 ± 3.3 months. The operation time of the mesh group was longer than that of the conventional group (P < 0.001). There were minor differences in acetabular anteversion and abduction angle, and the other data showed no differences. MRI results indicated that the success rate of capsular repair was higher in the mesh group (50 hips, 98%) than in the conventional group (37 hips, 67%) (P < 0.001), and the others failed the repair. Three dislocations occurred in the conventional group, while none occurred in the mesh group. The preoperative HHS (30 points) and postoperative HHS (82 points) of the mesh group were similar to those (35 points, 83 points) of the conventional group (P = 0.164, P = 0.328). Satisfaction had no difference (P = 0.532). CONCLUSIONS Compared to conventional repair, mesh reconstruction can effectively maintain capsular integrity and decrease dislocation risk after THA without increasing complications. LEVEL OF EVIDENCE Therapeutic study, Level IA.
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Affiliation(s)
- Peng Xin
- grid.488137.10000 0001 2267 2324Medical School of Chinese People’s Liberation Army, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Fuxing Road, Haidian District, Beijing, 100048 China ,grid.414252.40000 0004 1761 8894Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048 China ,Department of Orthopedics, Chinese PLA Southern Theater Command General Hospital, Guangzhou, 510010 China
| | - Ming Ni
- grid.414252.40000 0004 1761 8894Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Fuxing Road, Haidian District, Beijing, 100048 China ,grid.414252.40000 0004 1761 8894Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048 China
| | - Quanbo Ji
- grid.414252.40000 0004 1761 8894Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Fuxing Road, Haidian District, Beijing, 100048 China ,grid.414252.40000 0004 1761 8894Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048 China
| | - Xiaoxi Yang
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, Beijing, 100191 China
| | - Lei Geng
- grid.414252.40000 0004 1761 8894Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Fuxing Road, Haidian District, Beijing, 100048 China ,grid.414252.40000 0004 1761 8894Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048 China
| | - Yan Wang
- Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Fuxing Road, Haidian District, Beijing, 100048, China. .,Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
| | - Guoqiang Zhang
- Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Fuxing Road, Haidian District, Beijing, 100048, China. .,Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
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Huang YY, Chen IJ, Wu CT, Chan YS, Chen DWC, Tang HC. The posterior capsule is distended in dysplastic hips, but the anterior capsule is not. Knee Surg Sports Traumatol Arthrosc 2023; 31:79-85. [PMID: 36315266 DOI: 10.1007/s00167-022-07207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/21/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE In the setting of acetabular dysplasia, the increased translational motion of the femur may damage the labrum and cartilage, as well as stretch the capsule. The purpose of the study was to investigate the relationship between the acetabular coverage and the capsular stiffness by assessing the distension of anterior and posterior joint recesses on the hip computed tomography arthrography. METHODS One hundred thirty-three patients (138 hips) with a median age of 36 years (range 18-50 years) who received the computed tomography arthrography for evaluation of nonarthritic hip pain in our institute between 2015 and 2017 were retrospectively reviewed. The maximal distance between the anterior/posterior capsule and the anterior femoral head-neck junction/posterior femoral head on the axial imaging of computed tomography arthrography was defined as the width of anterior/posterior joint recess. The width of anterior/posterior joint recess was adjusted with the diameter of the femoral head and was then compared between acetabular dysplasia (lateral center-edge angle < 25°), normal acetabulum (lateral center-edge angle between 25 and 39°), and deep acetabulum (lateral center-edge angle > 39°). In addition, the standard univariate linear regression analysis was used to investigate the relationship between the adjusted width of anterior/posterior joint recess and anterior/posterior coverage of the hip, determined by the anterior/posterior wall index. RESULTS The adjusted width of posterior joint recess was significantly greater in the acetabular dysplasia group than the normal acetabulum and deep acetabulum groups (p < 0.01 and p = 0.02, respectively). There was no significant difference of the adjusted width of anterior joint recess between the groups (n.s.). The adjusted width of posterior joint recess had a significant but weak negative correlation with the anterior wall index (r = - 0.25, p < 0.001), and no correlation with the posterior wall index (r = - 0.0004, n.s.). There was no significant correlation between the adjusted width of anterior joint recess and the anterior/posterior wall index (r = 0.05, n.s./r = 0.07, n.s.). CONCLUSIONS The distension of posterior capsule on the computed tomography arthrography was significantly greater in acetabular dysplasia. In addition, there was a significant but weak negative correlation between the distension of posterior capsule and the anterior coverage of the hip. It indicated a looser posterior capsule was observed in a dysplastic hip. The relevance of posterior capsular laxity to clinical outcomes warrants further investigation. Given the fact that the distension of anterior capsule was not significantly higher in acetabular dysplasia, the need of anterior capsular plication in a dysplastic hip should be carefully evaluated. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yu-Yi Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan
| | - I-Jung Chen
- College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan, 333, Taiwan
| | - Chen-Te Wu
- College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan, 333, Taiwan
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan.,College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan
| | - Dave Wei-Chih Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan.,College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan. .,College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan.
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Tamaki Y, Goto T, Iwase J, Wada K, Hamada D, Tsuruo Y, Sairyo K. Contributions of the ischiofemoral ligament, iliofemoral ligament, and conjoined tendon to hip stability after total hip arthroplasty: A cadaveric study. J Orthop Res 2022; 40:2885-2893. [PMID: 35266582 DOI: 10.1002/jor.25320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
An adequate soft tissue balance is important in total hip arthroplasty (THA). This study assessed the contribution of the iliofemoral ligament, ischiofemoral ligament, and conjoined tendon to the range of hip rotation after THA and hip stability in response to axial traction. THA was performed in eight fresh-frozen cadaveric specimens via an anterolateral approach using a navigation system. The ischiofemoral ligament, the medial arm of the iliofemoral ligament, and the conjoined tendon were resected in that order. The ranges of external and internal rotation and the amount of movement of the femoral head in response to axial traction were measured with the hip in 10° of extension, the neutral position, and in 10°, 30°, and 60° of flexion. Resection of the medial arm of the iliofemoral ligament significantly increased the range of external rotation in 10° of extension, the neutral position, and in 10°, 30°, and 60° of flexion. The conjoined tendon was the most important inhibitor of internal rotation from 10° of extension to 30° of flexion. Although each single element had a minor role in stabilizing the hip when axial traction was applied, resection of two or more elements significantly affected joint stability. The iliofemoral ligament and conjoined tendon are the main inhibitors of external rotation and internal rotation, respectively, when THA is performed using an anterior or anterolateral approach. Resection of two or more elements could greatly affect hip stability when axial traction is applied.
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Affiliation(s)
- Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Joji Iwase
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshihiro Tsuruo
- Department of Anatomy and Cell Biology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Konno K, Hagiwara S, Nakamura J, Suzuki T, Eguchi Y, Ohtori S. An Anatomic Study of the Relationship Between the Iliocapsularis Muscle and Iliofemoral Ligament in Total Hip Arthroplasty. Arthroplast Today 2021; 12:57-61. [PMID: 34765713 PMCID: PMC8571414 DOI: 10.1016/j.artd.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background The preservation of soft tissues is an important factor for preventing dislocation after total hip arthroplasty. Anatomical studies have revealed that the inferior iliofemoral ligament (ILFL) contributes significantly to the native stability of the hip. This study aimed to investigate the anatomical structures of the iliocapsularis muscle (ICM) and ILFL from a surgical perspective. Methods In total, we assessed 50 hip specimens from 25 embalmed cadavers. The size and location of ICM and ILFL (at the upper, middle, and lower parts of the femoral head) were assessed in a neutral position. The ratio of ICM and ILFL widths to the femoral head was evaluated. Results The mean ICM and ILFL widths were 7.5 and 14.6, 12.0 and 14.2, and 12.8 and 15.2 mm at the upper, middle, and lower levels, respectively. The mean ICM thicknesses were 1.3, 9.0, and 9.1 mm at the upper, middle, and lower levels, respectively. The distributions of ICM and ILFL from the lateral edge of the femoral head were 21.1%–37.4% and 4.9%–36.5%, 9.5%–35.6% and 7.9%–38.7%, and 11.0%–38.7% and 9.5%–42.4% at the upper, middle, and lower levels, respectively. Conclusion ICM and ILFL were located at the anterolateral side of the femoral head, and the medial edge of the ILFL corresponded to that of the ICM. ICM can serve as a landmark for preserving ILFL in total hip arthroplasty using the anterior approach.
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Affiliation(s)
- Kenta Konno
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Takane Suzuki
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
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9
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Laumonerie P, Dalmas Y, Tibbo ME, Robert S, Durant T, Caste T, Vialla T, Tiercelin J, Gracia G, Chaynes P. Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature. PAIN MEDICINE 2021; 22:1149-1157. [PMID: 33565587 DOI: 10.1093/pm/pnab061] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the hip joint and the distribution of sensory receptors within its capsule. METHODS Five electronic databases were queried, with the search encompassing articles published between January 1945 and June 2019. Twenty-one original articles providing a detailed description of sensory receptors around the hip joint capsule (n=13) and its articular branches (n=8) were reviewed. RESULTS The superior portions of the anterior capsule and the labrum were found to be the area of densest nociceptive innervation. Similar to the distribution of nociceptors, mechanoreceptor density was found to be higher anteriorly than posteriorly. Hip joint capsular innervation was found to consistently involve the femoral and obturator nerves, which supply the anterior capsule, and the nerve to the quadratus femoris, which supplies the posterior capsule. The femoral, obturator, and superior gluteal nerves supply articular branches to the most nociceptor-rich region of the hip capsule. CONCLUSIONS The femoral and obturator nerves and the nerve to the quadratus femoris were found to consistently supply articular branches to both the anterior and posterior capsule of the hip joint. The anterior capsule, primarily supplied by the femoral and obturator nerves, and the superior labrum appear to be the primary pain generators of the hip joint, given their higher density of nociceptors and mechanoreceptors. LEVEL OF EVIDENCE Anatomy study, literature review.
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Affiliation(s)
- Pierre Laumonerie
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, Toulouse, France.,Anatomy Laboratory, Rangueil University Hospital, Toulouse, France
| | - Yoann Dalmas
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzanne Robert
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Thibault Durant
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Thomas Caste
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Tristan Vialla
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Joris Tiercelin
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Gauthier Gracia
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Patrick Chaynes
- Anatomy Laboratory, Rangueil University Hospital, Toulouse, France
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10
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Yi KH, Lee KL, Lee JH, Hu HW, Lee K, Seo KK, Kim HJ. Guidelines for botulinum neurotoxin injections in piriformis syndrome. Clin Anat 2020; 34:1028-1034. [PMID: 33347678 DOI: 10.1002/ca.23711] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The piriformis muscle is normally involved in piriformis syndrome and can be treated with botulinum neurotoxin using several different injection methods. However, definitive injection guidelines for the muscle have not been reported previously. AIMS This study aimed to determine the ideal area for injections based on the intramuscular nerve distribution as obtained using a modified Sihler's staining technique. MATERIALS AND METHODS A modified Sihler's method was applied to the piriformis muscle in 15 specimens. The intramuscular arborization areas were identified based on two anatomical landmarks: (a) the lateral border of the sacrum bone and (b) the greater trochanter. RESULTS The nerve entry point for both piriformis muscles was found in the area between the lateral border of the sacrum and one-fifth of the distance toward the greater trochanter. The intramuscular nerve distribution for the piriformis muscle had the largest arborization patterns between one-fifth and two-fifths of the distance from the sacrum to the greater trochanter. The piriformis muscle was tendinous from two-fifths of the distance to the greater trochanter. DISCUSSION This study has yielded suggested optimal injection locations for the piriformis muscle relative to external anatomical landmarks. CONCLUSION Clinicians can use these guidelines to ensure the effectiveness of not only botulinum neurotoxin injections but also other agents such as steroids, anesthetics, and normal saline. These guidelines will also help to avoid adverse outcomes of injection treatments.
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Affiliation(s)
- Kyu-Ho Yi
- Inje County Public Health Center, Inje-gun, South Korea.,Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kyu-Lim Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ji-Hyun Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hye-Won Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kangwoo Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | | | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea.,Department of Materials Science & Engineering, College of Engineering, Yonsei University, Seoul, South Korea
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11
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胡 翰, 王 静, 卢 志, 范 卫. [Prognostic evaluation of hip joint function following capsule repair based on a threedimensional finite element analysis model]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1826-1830. [PMID: 33380395 PMCID: PMC7835689 DOI: 10.12122/j.issn.1673-4254.2020.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To construct a three-dimensional (3D) finite element mechanical model of total hip arthroplasty for comparison of biomechanical differences of the hip joint following capsule repair and postoperative rehabilitation. METHODS Six frozen specimens of hip joint posterior capsule ligament complex were collected in a bone-capsule-bone manner, and the load-strain curve and other mechanical properties of the specimens were tested using a universal material testing machine. Thin-section CT data of the pelvis and lower limbs obtained from a volunteer were imported into Mimics software to construct a 3D model of the hip joint. Digital models of the cup, femoral prosthesis and joint capsule were created in CATIA software and imported into Mimics to simulate total hip arthroplasty; the assembled data were imported into ABAQUS software. The properties of the capsule were set according to results of the mechanical test, anatomical studies, and constitutive equations, and the biomechanics of the anatomically repaired and conventionally repaired capsules were compared during hip flexion. RESULTS The results of testing on the 6 capsule specimens showed a mean ultimate tensile strain of (39.21±5.23)% and a mean of ultimate tensile strength of 1.65±0.38 MPa. The stress-strain curve of the finite element model was consistent with the results of mechanical test on the specimens and the biochemical characteristics of the capsule. The stress was distributed evenly in the anatomically repaired capsule during hip flexion but not in the capsule repaired through the conventional approach; the tensile stress in the lower part of the conventionally repaired capsule reached the ultimate tensile stress measured on the capsule specimens at a 90° flexion. CONCLUSIONS The finite element model allows dynamic, quantitative and visual assessment of stress distribution in the hip joint capsule, and compared with the conventional approach, anatomical repair can achieve better biomechanical properties of the capsule.
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Affiliation(s)
- 翰生 胡
- 南京医科大学第一附属医院骨科,江苏 南京 210029Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- 江苏苏北人民医院骨科,江苏 扬州 225000Department of Orthopedics, Subei People's Hospital, Yangzhou 225000, China
| | - 静成 王
- 江苏苏北人民医院骨科,江苏 扬州 225000Department of Orthopedics, Subei People's Hospital, Yangzhou 225000, China
| | - 志华 卢
- 江苏苏北人民医院骨科,江苏 扬州 225000Department of Orthopedics, Subei People's Hospital, Yangzhou 225000, China
| | - 卫民 范
- 南京医科大学第一附属医院骨科,江苏 南京 210029Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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12
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Tamaki Y, Goto T, Wada K, Hamada D, Tsuruo Y, Sairyo K. Anatomic evaluation of the insertional footprints of the iliofemoral and ischiofemoral ligaments: a cadaveric study. BMC Musculoskelet Disord 2020; 21:828. [PMID: 33298008 PMCID: PMC7727247 DOI: 10.1186/s12891-020-03848-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/30/2020] [Indexed: 11/15/2022] Open
Abstract
Background An understanding of the insertional footprints of the capsular ligaments of the hip is important for preserving hip function and stability given the increasing number of minimally invasive hip surgeries being performed under a limited surgical view. However, it is difficult to detect these ligaments intraoperatively and many surgeons may not fully appreciate their complex anatomy. The aims of this study were to quantify the proximal and distal footprints of the iliofemoral ligament (ILFL) and ischiofemoral ligament (ISFL) and to estimate the location of the corresponding osseous landmarks on the proximal femur, which can be detected easily during surgery. Methods Twelve hip joints from Japanese fresh frozen cadavers were used. All muscle, fascia, nerve tissue, and vessels were removed to expose the intact capsular ligaments of the hip. The length and width of the proximal and distal footprints of the ILFL and ISFL were measured and their relationship to osseous structures was evaluated, including the intertrochanteric line, femoral neck, and lesser trochanter. Results The mean length of the distal medial arm of the ILFL footprint was 17.9 mm and the mean width was 9.0 mm. The mean length of the distal lateral arm of the ILFL footprint was 23.0 mm and the mean width was 9.7 mm. For the footprint of the medial arm, the insertion was in the distal third of the intertrochanteric line and that of the lateral arm was in the proximal 42% of this line. The mean distance from the lesser trochanter to the footprint of the medial arm was 24.6 mm. The mean length of the distal ISFL footprint was 11.3 mm and the mean width was 6.9 mm. The footprint of the distal ISFL was located forward of the femoral neck axis in all specimens. Conclusions Understanding the size and location of each capsular ligament footprint in relation to an osseous landmark may help surgeons to manage the hip capsule intraoperatively even under a narrow surgical view. The findings of this study underscore the importance of recognizing that the distal ISFL footprint is located relatively forward and very close to the distal lateral arm footprint.
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Affiliation(s)
- Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Yoshihiro Tsuruo
- Department of Anatomy and Cell Biology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
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Reconstruction of Bony Defects after Tumor Resection with 3D-Printed Anatomically Conforming Pelvic Prostheses through a Novel Treatment Strategy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8513070. [PMID: 33335928 PMCID: PMC7723494 DOI: 10.1155/2020/8513070] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/09/2020] [Accepted: 11/11/2020] [Indexed: 01/07/2023]
Abstract
There has been an increasing interest and enormous applications in three-dimensional (3D) printing technology and its prosthesis, driving many orthopaedic surgeons to solve the difficult problem of bony defects and explore new ways in surgery approach. However, the most urgent problem is without an effective prosthesis and standard treatment strategy. In order to resolve these problems, this study was performed to explore the use of a 3D-printed anatomically conforming pelvic prosthesis for bony defect reconstruction following tumor resection and to describe a detailed treatment flowchart and the selection of a surgical approach. Six patients aged 48-69 years who had undergone pelvic tumor resection underwent reconstruction using 3D-printed anatomically conforming pelvic prostheses according to individualized bony defects between March 2016 and June 2018. According to the Enneking and Dunham classification, two patients with region I+II tumor involvement underwent reconstruction using the pubic tubercle-anterior superior iliac spine approach and the lateral auxiliary approach and one patient with region II+III and three patients with region I+II+III tumor involvement underwent reconstruction using the pubic tubercle-posterior superior iliac spine approach. The diagnoses were chondrosarcoma and massive osteolysis. After a mean follow-up duration of 30.33 ± 9.89 months (range, 18-42), all patients were alive, without evidence of local recurrence or distant metastases. The average blood loss and blood transfusion volumes during surgery were 2500.00 ± 1461.51 ml (range, 1200-5000) and 2220.00 ± 1277.62 ml (range, 800-4080), respectively. During follow-up, the mean visual analogue scale (VAS) score decreased, and the mean Harris hip score increased. There were no signs of hip dislocation, prosthetic loosening, delayed wound healing, or periprosthetic infection. This preliminary study suggests the clinical effectiveness of 3D-printed anatomically conforming pelvic prostheses to reconstruct bony defects and provide anatomical support for pelvic organs. A new surgical approach that can be used to expose and facilitate the installation of 3D-printed prostheses and a new treatment strategy are presented. Further studies with a longer follow-up duration and larger sample size are needed to confirm these encouraging results.
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14
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The effect of high, medium and low mobilization forces applied during a hip long-axis distraction mobilization on the strain on the inferior ilio-femoral ligament and psoas muscle: A cadaveric study. Musculoskelet Sci Pract 2020; 47:102148. [PMID: 32174546 DOI: 10.1016/j.msksp.2020.102148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several studies have suggested that the changes in elasticity of the joint capsule and surrounding muscles during a hip long-axis distraction mobilization (LADM) could explain the pain-relieving and mobility-improving effects of the technique. OBJECTIVE To compare the strain on the inferior ilio-femoral ligament and psoas muscle when applying three different magnitudes of force during LADM. DESIGN Repeated measures controlled laboratory cadaveric study. METHODS Eleven hip joints were mobilized from six fresh-frozen cadavers (mean age, 73.4 ± 5.7 years). Three magnitudes of force (low, medium and high) were applied during a hip LADM in open-packed position according to grades of joint mobilization. Strain on the inferior ilio-femoral ligament and psoas muscle were measured with strain gauges. The magnitude of the force applied during LADM was recorded. RESULTS Strain on the inferior ilio-femoral ligament during a high-force LADM was significantly higher than strain on the inferior ilio-femoral ligament during low (p < 0.001) and medium-force LADM (p < 0.001). The strain on the inferior ilio-femoral ligament during a medium-force LADM was significantly higher than during a low-force LADM (p = 0.004). No changes in strain on psoas muscle were observed. The magnitude of force applied during LADM showed a significant progressive increase from low to high-force LADM. CONCLUSION The different magnitudes of forces applied during LADM produce different strains on the inferior ilio-femoral ligament but not on the psoas muscle. The strain on the inferior ilio-femoral ligament during LADM depends on the magnitude of the mobilization force.
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15
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Ding ZC, Zeng WN, Mou P, Liang ZM, Wang D, Zhou ZK. Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip. Orthop Surg 2020; 12:589-600. [PMID: 32227469 PMCID: PMC7189031 DOI: 10.1111/os.12665] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate whether the risk of dislocation after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) is high and to further identify the risk factors for postoperative dislocation in these patients. Methods This retrospective cohort study reviewed Crowe type IV DDH patients undergoing THA between January 2009 and December 2017 in our institution. Each Crowe type IV DDH patient was matched with three Crowe type I, II, or III DDH patients according to gender, side and date of operation. The primary outcome of this study was postoperative dislocation after THA. Occurrence, rate, classification, treatment and outcome of dislocation were documented in detail for all patients. The dislocation rates were compared between Crowe type IV DDH patients and Crowe type I, II, or III DDH patients. Demographic data, implant factors, and surgical factors were compared between the dislocation and no dislocation groups. Multiple logistic regression analysis was used to determine the independent risk factors for dislocation in Crowe type IV hips. Results A total of 131 Crowe type IV hips were followed up for a mean of 76.5 ± 28.1 months. Three hundred and ninety‐three Crowe type I, II and III hips, including 261 type I hips, 94 type II hips, and 38 type III hips, were identified as controls and followed up for a mean of 76.4 ± 28.2 months. No significant difference was observed in follow‐up time between two groups (P = 0.804). One or more dislocations occurred in 22 of the 524 dysplasia hips (4.20%). Of the 22 dislocated hips, 20 hips (90.9%) were successfully managed with non‐operative treatment. Two patients (9.1%, one Crowe type I and one Crowe type IV) experienced recurrent dislocation and required revision surgery. Crowe type IV hips had a significantly higher postoperative dislocation rate than type I, II, and III hips (11.45% vs 1.78%, P < 0.001). The use of a 22‐mm femoral head (odds ratio [OR] = 23.55, 95% confidence interval [CI] = 1.901–291.788, P = 0.014), older age (OR = 1.128, 95% CI = 1.037–1.275, P = 0.031), and absence of false acetabulum (OR = 12.425, 95% CI = 1.982–77.879, P = 0.007) were identified as independent risk factors for dislocation in Crowe type IV hips. Conclusions Crowe type IV DDH patients were at a high risk of dislocation after THA, and using large femoral heads and improving abductor muscle strength may help decrease the rate of postoperative dislocation in such patients.
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Affiliation(s)
- Zi-Chuan Ding
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Wei-Nan Zeng
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Ping Mou
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhi-Min Liang
- Clinic Research Management Department, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Duan Wang
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zong-Ke Zhou
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
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Lu Y, Xiao H, Xue F. Causes of and treatment options for dislocation following total hip arthroplasty. Exp Ther Med 2019; 18:1715-1722. [PMID: 31410129 PMCID: PMC6676097 DOI: 10.3892/etm.2019.7733] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022] Open
Abstract
The second most common complication following total hip arthroplasty (THA) is dislocation. The majority of dislocations occur early in the post-operative period and are due to either patient-associated or surgical factors. The patient-associated factors that have been implicated as causes of post-operative dislocation include previous surgery, lumbar spine fusion surgery and/or neurological impairment. The surgical factors include surgical approach, component orientation and prosthetic and/or bony impingement. In order to delineate the cause of the hip instability a thorough history and physical and a radiographic assessment (possibly including advanced imaging) needs to be performed. Approximately two thirds of cases are successfully treated; one third of cases will require surgical treatment (e.g., revision arthroplasty (including constrained liners, the use of elevated rim liners and dual mobility implants or trochanteric advancement). In this review, we discuss the causes leading to dislocation following THA and evaluate the different treatment options available.
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Affiliation(s)
- Yian Lu
- Department of Orthopedics, Fengxian Central Hospital, Shanghai 201400, P.R. China
| | - Haijun Xiao
- Department of Orthopedics, Fengxian Central Hospital, Shanghai 201400, P.R. China
| | - Feng Xue
- Department of Orthopedics, Fengxian Central Hospital, Shanghai 201400, P.R. China
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Logishetty K, van Arkel RJ, Ng KCG, Muirhead-Allwood SK, Cobb JP, Jeffers JRT. Hip capsule biomechanics after arthroplasty. Bone Joint J 2019; 101-B:426-434. [DOI: 10.1302/0301-620x.101b4.bjj-2018-1321.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aims The hip’s capsular ligaments passively restrain extreme range of movement (ROM) by wrapping around the native femoral head/neck. We determined the effect of hip resurfacing arthroplasty (HRA), dual-mobility total hip arthroplasty (DM-THA), conventional THA, and surgical approach on ligament function. Materials and Methods Eight paired cadaveric hip joints were skeletonized but retained the hip capsule. Capsular ROM restraint during controlled internal rotation (IR) and external rotation (ER) was measured before and after HRA, DM-THA, and conventional THA, with a posterior (right hips) and anterior capsulotomy (left hips). Results Hip resurfacing provided a near-native ROM with between 5° to 17° increase in IR/ER ROM compared with the native hip for the different positions tested, which was a 9% to 33% increase. DM-THA generated a 9° to 61° (18% to 121%) increase in ROM. Conventional THA generated a 52° to 100° (94% to 199%) increase in ROM. Thus, for conventional THA, the capsule function that exerts a limit on ROM is lost. It is restored to some extent by DM-THA, and almost fully restored by hip resurfacing. In positions of low flexion/extension, the posterior capsulotomy provided more normal function than the anterior, possibly because the capsule was shortened during posterior repair. However, in deep flexion positions, the anterior capsulotomy functioned better. Conclusion Native head-size and capsular repair preserves capsular function after arthroplasty. The anterior and posterior approach differentially affect postoperative biomechanical function of the capsular ligaments. Cite this article: Bone Joint J 2019;101-B:426–434.
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Affiliation(s)
- K. Logishetty
- Speciality Trainee in Trauma & Orthopaedics, MSk Lab, Imperial College London, London, UK
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - R. J. van Arkel
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - K. C. G. Ng
- Department of Mechanical Engineering, Imperial College London, London, UK
| | | | - J. P. Cobb
- MSk Lab, Imperial College London, London, UK
| | - J. R. T. Jeffers
- Department of Mechanical Engineering, Imperial College London, London, UK
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Zhao G, Zhu R, Jiang S, Xu C, Xu N, Wang Y. Soft tissue restrictors of femoral elevation in direct anterior approach-an anatomic study. J Orthop Surg Res 2018; 13:308. [PMID: 30514330 PMCID: PMC6280390 DOI: 10.1186/s13018-018-1012-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022] Open
Abstract
Background With the patient in a constant supine position, elevation of the femur in THA (DAA) provides a more intuitive and conducive location of the acetabulum for the correct placement of the acetabular prosthesis, but elevation of the femur for broaching becomes more challenging. The purpose of this study is to analyze the restriction of the ischiofemoral ligament and short external rotation muscles, and its effect on the elevation of the proximal femur in the DAA. Methods The study subjects comprised 5 freshly frozen cadavers with 10 normal hips. All of the anatomic dissections of all of the hips were performed through the DAA. The ischiofemoral ligament, piriformis, conjoint tendon, and external obturator were successively resected. All of the proximal femurs of the specimens were levered by a point tip curved retractor that was connected with a dynamometer. Through preliminary measurements, an applied force of 80 N was adopted and maintained on the curved retractor. The experiment was repeated to measure the displacement of the proximal femur being raised after the posterior structures of the hip joint had been resected in a stepwise fashion. The displacement of the retractor was recorded, and the data were then analyzed. Results The distance significantly increased after the ischiofemoral ligament was severed (P < 0.001). A prominent increase was demonstrated after the conjoint tendons were severed (P < 0.001). The distance insignificantly increased after the piriformis was severed (P > 0.05). After the obturator externus was cut off, the distance increased by an insignificant amount (P > 0.05). Conclusion In DAA, the ischiofemoral ligament contributed stability when the femur was being raised. The main contribution of restriction was provided by the conjoint tendon. The tendons of the obturator externus muscle and piriformis muscle did not provide any significant restriction when the femur was being raised.
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Affiliation(s)
- Gongyin Zhao
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China
| | - Ruixia Zhu
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China
| | - Shijie Jiang
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China
| | - Chao Xu
- Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 210039, People's Republic of China
| | - Nanwei Xu
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China
| | - Yuji Wang
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China. .,Departments of Orthopedic Surgery and Biochemistry and Molecular Biology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Fagotti L, Kemler BR, Utsunomiya H, Storaci HW, Krob JJ, Brady AW, Turnbull TL, Philippon MJ. Effects of Capsular Reconstruction With an Iliotibial Band Allograft on Distractive Stability of the Hip Joint: A Biomechanical Study. Am J Sports Med 2018; 46:3429-3436. [PMID: 30382750 DOI: 10.1177/0363546518802841] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The capsular ligaments and the labral suction seal cooperatively manage distractive stability of the hip. Capsular reconstruction using an iliotibial band (ITB) allograft aims to address capsular insufficiency and iatrogenic instability. However, the extent to which this procedure may restore hip distractive stability after a capsular defect is unknown. PURPOSE To evaluate the biomechanical effects of capsular reconstruction on distractive stability of the hip joint. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen cadaveric hip specimens were dissected to the level of the capsule and axially distracted in 3 testing states: intact capsule, partial capsular defect, and capsular reconstruction with an ITB allograft. Each femur was compressed with 500 N of force and then distracted 6 mm relative to the neutral position at 0.5 mm/s. Distractive force was continuously recorded, and the first peak delineating 2 phases of hip distractive stability in the force-displacement curve was analyzed. RESULTS The median force at maximum distraction in the capsular reconstruction state (156 N) was significantly greater than that in the capsular defect state (89 N; P = .036) but not significantly different from that in the intact state (218 N; P = .054). Median values for distractive force at first peak (60 N, 72 N, and 61 N, respectively; P = .607), distraction at first peak (2.3 mm, 2.3 mm, and 2.5 mm, respectively; P = .846), and percentage decrease in distractive force (35%, 78%, and 63%, respectively; P = .072) after the first peak were not significantly different between the intact, defect, and reconstruction states. CONCLUSION Capsular reconstruction with an ITB allograft significantly increased the force required to distract the hip compared with a capsular defect in a cadaveric model. To our knowledge, this is the first study to report an initial peak distractive force and to propose 2 distinct phases of hip distractive stability. CLINICAL RELEVANCE The consequences of a capsular defect on distractive stability of the hip may be underappreciated among the orthopaedic community; with that said, capsular reconstruction using an ITB allograft provided significantly increased distractive stability and should be considered an effective treatment option for patients with symptomatic capsular deficiency.
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Affiliation(s)
| | | | | | | | - Joseph J Krob
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Alex W Brady
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Soft tissue tension is four times lower in the unstable primary total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 42:2059-2065. [DOI: 10.1007/s00264-018-3908-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/16/2018] [Indexed: 01/25/2023]
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